The clip piston: Safe attachment of the stapes prosthesis provides better hearing

Abstract

Objectives: In stapes surgery, audiological results were not predictable due to insecure coupling to the long process of the incus. Micromovements may result in a persistent air-bone gap. This retrospective study evaluates the audiological outcome comparing the new clip piston to 3 previous stapes prostheses inserted by the same surgeon. Methods: A total of 120 patients underwent stapes surgery in stapedotomy technique. Four different stapes prosthesis were used in 4 different time periods: Clip piston, titanium loop, gold piston, and teflon-wire piston. Audiological results are compared using pure tone audiometry and speech audiometry. Results: Audiometric results show better hearing results in the group with the clip piston. The most significant difference is in speech understanding. For the surgeon, the clip piston facilitates stapes surgery because there is no more crimping needed. Surgical time is shortened by an average of 5 minutes. The prosthesis always holds firm and in the correct position. It is FDA-approved. Conclusions: With the new titanium clip piston, stapes surgery is safer, more effective, and faster. Firm attachment provides better hearing. Unlike other pistons, the clip piston does not strangle the incus thus reducing the risk for incus necrosis. The clip piston was first implanted in September 2000 and no loosening of the fixation has been reported yet in several thousands of patients. Starting in 2002, this clip piston is being used worldwide with benefit to the patient and the surgeon.